The Child with Mental Health or Behavioural Issues

Question 1

How does the DSM define ADHD? Don’t list the whole criteria, just the main parts and some examples

Answer 1

• A - persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development characterised by (1) and/or (2)
• 1 - Inattention - 6+ of the following >6 months, inconsistent with developmental stage, socio-occupational dysfunction
  
  • Fails to give close attention to tasks, makes careless mistakes
  • Difficulty sustaining attention in tasks, class or play
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork/chores (side-tracking)
  • Difficulty organising tasks, activities
  • Avoids or dislikes tasks requiring sustained mental effort
  • Often loses things necessary for tasks activities (glasses, pens, paperwork etc.)
  • Easily distracted
  • Often forgetful in daily activities
• 2 - Hyperactivity/Impulsivity - 6+ of the following >6 months, inconsistent with developmental stage, socio-occupational dysfunction
  
  • Often fidgets with hands or feet, or squirms in seat
  • Often leaves seat in situations where remaining seated is expected
  • Often runs about or climbs excessively in appropriate situations
  • Difficulty playing or engaging in leisure activities quietly
  • Often on-the-go, uncomfortable being still for extended times
  • Often talks excessively
  • Often blurts out answers before question is completed
  • Has difficulty waiting in turn
  • Often interrupts or intrudes on others

Question 2

Describe the management of ADHD

Answer 2

• Behaviour modification
  
  • Best when parents and teachers work together using the same strategies
• Educational strategies
  
  • Seating at the front of the class, minimising distractions, reminders, teacher’s aide
• Medications (most effective intervention)
  
  • Stimulants (dexamphetamine, methylphenidate [Ritalin])
  • Atomoxetine (SNRI), clonidine, SSRI/TCAs also used

Question 3

How does does oppositional defiant disorder difffer from ADHD?

Answer 3

• Often co-exists with ADHD, but not exclusively limited to situations requiring sustained attention
  
  • Often used as a diagnosis to avoid the ADHD label and instead focus on the situation/stressors sustaining this behaviour
• Behavioural more “oppositional” - angry, argumentative, spiteful, defiant